With entire attention focussed on the vital hygienic aspects of the women’s monthly cycle, awareness is missing at the ground level about stormy upheavals like PMS and PMDD which are pushing young females to the margins of insanity, reports Babra Wani
On January 26, this year, Raima experienced the onset of a troubling period in her life. Initially, she brushed it off as nothing serious, but as time passed, her situation took a turn for the worse. A pattern emerged, and it became evident that her difficult days coincided with her monthly menstrual cycle.
At the age of 25, her behaviour became increasingly erratic, and she found herself spending most of her time in tears. Recalling this period, she described it as the worst phase of her life. There were moments when she approached her family, burdened with guilt, and even contemplated suicide. “My days were so dire that I could not even close my eyes at night because I believed that doing so would lead to my demise,” she recalled. “It was that severe. I not only suffered through sleepless nights, but my parents also endured restless nights worrying about me.”
As her agony deepened, Raima’s frantic behaviour escalated. She began reaching out to friends and acquaintances, seeking forgiveness, and expressing her fear of impending death. “These episodes not only took a toll on me but also started affecting my family, who had a tough time dealing with my emotional turmoil.”
Raima had a history of chronic depression and self-harm tendencies, which had been previously treated. “In 2015, I went through a similar phase, but nearly a decade later, I started experiencing these thoughts and emotions again during the winter months,” she said. “This not only triggered anxiety in me but also caused my parents immense worry. I even began sleeping with them, and there were days when my father couldn’t go to work because he was deeply concerned about my well-being.”
At times, Raima’s family considered supernatural forces to be the cause of her suffering and resorted to protective rituals like burning Esfand (isband in Kashmiri). Her mother expressed the profound distress they all felt. “It was a terrible ordeal, I swear by Allah. Witnessing my daughter’s condition brought me to tears, and we were at a loss as to what was afflicting her,” the mother said.
The impact was not limited to Raima’s mental health; it also took a toll on her physical well-being. She noticed significant weight loss, a drop in her blood pressure, severe headaches, and intensified abdominal pains, particularly during her periods.
One day, while browsing the internet, Raima decided to investigate why she experienced such challenging days before her menstrual cycle. She stumbled upon two terms, PMS (Premenstrual Syndrome) and PMDD (Premenstrual Dysphoric Disorder). The more she read about these terms, the more she realised they held the key to understanding what she had been enduring.
PMS and PMDD
PMS and PMDD are two pre-menstrual conditions that affect women. While women in Kashmir are no strangers to these experiences, the terminology itself is relatively new to the region.
PMS typically sets in about a week before the onset of menstruation and affects most women. It manifests through various signs and symptoms, such as mood swings, bloating, headaches, clumsiness, cramping, and hormonal fluctuations. This combination of mental and physical symptoms usually occurs following ovulation but before the start of the monthly cycle.
Researchers suggest that PMS emerges due to a sharp decline in estrogen and progesterone levels when pregnancy is not confirmed. As a woman’s menstruation begins, these symptoms gradually subside, aligning with the resurgence of hormone levels. The severity of PMS symptoms varies, with some women experiencing mild discomfort and others grappling with extreme distress, which can significantly impact their daily lives.
Severe PMS symptoms can evolve into PMDD, a condition that affects women in their childbearing age. Like PMS, PMDD occurs before menstruation and can result in extreme symptoms like depression, anxiety, suicidal thoughts, irritability, anger, feelings of hopelessness, loneliness, sadness, and even panic attacks.
Raima, upon learning about PMDD, recognised that she was indeed grappling with this condition. She sought help from a female psychiatrist who prescribed antidepressants and emphasised the importance of cultivating positive thoughts and making healthier lifestyle choices. “Gradually, I began adopting a more positive approach, and it has been nearly nine months since I experienced severe symptoms during my periods. Though I still experience significant mood swings,” she admitted.
A 2022 study Unfolding the Mystery of Premenstrual Syndrome (PMS): An Overview by Mehrukh Zehravi et al revealed that approximately 5–8 per cent of women experience premenstrual syndrome, with premenstrual dysphoric disorder (PMDD) accounting for most cases.
The Curious Case of PMS
Raima’s friend, 26-year-old Saiqa, has been grappling with severe Premenstrual Syndrome (PMS) for the past six years. Each month, in the days leading up to her periods, Saiqa takes a week off because, as she describes it, she starts PMSing badly. “There have been days when both my body and mind have given up on me. I withdraw from everything and shut down completely,” she shared. PMS often brings her sleepless nights, intrusive mood swings, and difficulty making decisions. “Most of these days, I feel unloved and end up crying, straining my relationships with friends and family.”
She also expressed her discomfort with physical changes like skin blemishes and the unease they bring. “I sometimes cry all day. Some days I oversleep, while on others, I cannot sleep at all. Even now, as we speak, I am in the midst of PMS, and I must admit, I am not enjoying this conversation.”
Mass Disorder
In the 2016 study Prevalence of Various Menstrual Disorders Among Females of Reproductive Age-Group of Kashmir: A Cross-Sectional Study conducted by Dr Sheema Samreen et al, it was found that PMS was the second most prevalent menstrual disorder among Kashmiri women. The diagnosis is primarily symptom-based, as there are no specific diagnostic tests available to confirm it.
Saiqa and her family were unaware of PMS, and they did not know where to turn for help until a friend enlightened her about the condition three years ago. She noted that many of her friends face similar challenges due to these premenstrual conditions, making their daily lives difficult.
Likewise, Shabnam frequently experiences PMS, with symptoms that include aggression, anger issues, and abdominal and back pain. “During those days, I felt like I could explode. My mood becomes volatile, and I despise social interaction. It all eases once my periods start,” she said. These women, along with many others, silently endure Premenstrual Disorders due to limited resources, a lack of knowledge, and the stigma associated with menstruation in Kashmiri society. “Initially, I did not even want to confide in my mother; I was afraid she would not understand.”
Echoing her sentiments, Shakeela, 45, revealed that she never told her mother when she had her first period, and she still has not spoken about it. “Despite my own experiences with both PMS and PMDD, I could not bring myself to discuss it with anyone,” she admitted. “I suffered in silence.” This silence, however, is not limited to just one or two individuals; countless women endure these disorders, as little has been done to address them.
The root of these syndromes lies in both psychological and physiological factors. Imbalanced hormones, especially before menstruation and ovulation, play a crucial role. The decrease in estrogen and progesterone levels during ovulation is a known trigger for PMS and PMDD. Fluctuations in serotonin levels throughout the menstrual cycle contribute to mood swings and irritability.
The Psychological Aspect
Dr Yasir Rather, a Professor at the GMC Srinagar’s IMHANS sheds light on the psychological dimension of these conditions. PMS symptoms typically emerge in a woman’s late 20s to early 30s, striking in the week or two preceding menstruations. These symptoms affect up to 80 per cent of menstruating women. In contrast, PMDD is less common, impacting 3-8 per cent of women, and also typically begins in the late 20s to early 30s. Both conditions are most prevalent among women aged 25-35 during their peak reproductive years.
The psychological symptoms of PMS and PMDD stem from the intricate interplay between reproductive hormones and brain chemicals, such as serotonin, he said. Negative mood fluctuations and thoughts, such as mood swings, anxiety, and depression, are common manifestations.
For treatment, Dr Yasir emphasises the potential of lifestyle changes like exercise and Cognitive Behavioural Therapy (CBT) to manage emotions and perceptions. Medications that regulate hormones and enhance neurotransmitters are also viable options. The key lies in adopting a multifaceted approach that addresses both the body and the mind. “Tracking symptoms and identifying triggers enable tailored treatment to minimise the psychological impact”, he added.
The Physiological Perspective
In line with Dr Yasir’s insights, several other medical practitioners concur that PMS is prevalent among women due to hormonal changes, leading to various physical manifestations such as bloating, breast swelling, abdominal pain, pimples, and acne.
One senior doctor, speaking on the condition of anonymity, noted that PMS is a widespread issue among women, often managed independently as many remain unaware of it and do not seek treatment. The lack of awareness and the accompanying stigma surrounding these menstrual disorders often deter individuals from seeking the help they require.
The most significant contributing factor to these disorders, as emphasised by the medical community, is hormonal imbalance. All these conditions are fundamentally psychosomatic, highlighting the intricate interplay between the body and the mind.
The Other Disorders
In addition to PMS and PMDD, several other menstrual disorders frequently affect women. One of the most common is Dysmenorrhoea, characterised by pain related to menstruation. More than half of menstruating women experience mild pain for one to two days each month. However, for some, the discomfort is so severe that it hinders their regular activities for a few days.
Dysmenorrhoea can be primary, starting at the onset of a period, or secondary, triggered by an underlying medical condition. Possible symptoms include lower abdominal pain or cramping, lower back pain, radiating leg pain, nausea, vomiting, diarrhoea, exhaustion, weakness, fainting, or headaches.
Another prevalent menstrual disorder is Menorrhagia, often referred to as heavy menstrual bleeding. It is commonly observed among Kashmiri women, particularly after PMS. According to the study Prevalence of Various Menstrual Disorders Among Females of Reproductive Age-Group of Kashmir: A Cross-Sectional Study, between 27 per cent and 54 per cent of individuals who menstruate experience heavy menstrual bleeding.
(Names of all women quoted in the report have been changed to protect their privacy.)
